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The Lung Ambition Alliance: Stronger together

Published on 09/10/19 at 11:05am

Following our piece by AstraZeneca's Patrick Connor introducing the Lung Ambition Alliance, a new cross-functional collaboration which aims to double five-year survival in lung cancer by 2025, Pharmafocus spoke to head figures from three of the Alliance’s founding partners to get a feel for how it will operate, how it will deliver on its aspiring promises, and what sets it apart from previous collaborative efforts.

International Association for the Study of Lung Cancer

Dr Giorgio Scagliotti, President of the International Association for the Study of Lung Cancer

Do you think that the level of collaboration that the Alliance is looking to leverage is what really gives the initiative the edge over previous efforts in lung cancer?

The partners share a same vision: to eliminate lung cancer as a cause of death. No one company or organisation can act alone to make meaningful progress in the fight against lung cancer.

We are bridging the commercial and non-profit sectors to bend the survival curve faster and improve outcomes for patients globally. Our diverse perspectives enable us to identify needs more precisely, while our depth of resources and broad network provides us the capabilities and reach to amplify our impact. We believe that by aligning on a shared goal, we can accelerate the pace of progress. 

If you look at accelerated improvements across other disease areas, you will see that it started with multiple stakeholders rallying together around a common cause and a compelling platform. For example, in breast cancer there was a consensus-driven prioritisation of policy goals, and in HIV there was a call for a common definition of treatment targets. 

What does the IASLC bring to the table within the wider coalition?

The IASLC is the creator of two key initiatives which are part of the Alliance. Firstly, the Early Lung Imaging Confederation (ELIC) project, which builds on evidence from recent lung cancer CT screening studies, showing a link between screening and the reduction of lung cancer mortality and presents a strong rationale for increasing screening efforts globally. Moreover, ELIC is a quality control exercise to improve the quality of the screening studies. We believe that to implement screening studies on a larger scale, we need to be sure that we are talking the same language.

Secondly is the thoracic cancer staging project, which began in 1997 to improve the Tumor, Node and Metastasis (TNM) Staging System, the most commonly used staging system for lung cancer. Since the project’s inception, the available data set of lung cancer patients has increased from about 6,000 (mostly in the US) to almost 95,000 (from 16 countries). 

What does the IASLC identify as the key challenges in lung cancer R&D now and in the coming years? How does being part of the Alliance enable the IASLC to overcome these challenges compared to if it had acted independently?

It is my personal conviction that we will not be able to significantly impact lung cancer mortality if we focus only on the treatment of metastatic disease. The fields of primary and secondary prevention are the ground for significant improvements, also taking into consideration the progress we have achieved in molecular diagnostics.

We at the IASLC are strong believers that the still-undiscovered value of precision medicine and of the rising digital era will generate benefits not previously achieved. Precision oncology is a new ecosystem that links clinicians, laboratories, research enterprises and clinical information system developers together in a new way. These efforts will create the foundation of a continuously learning healthcare system which represents the hope to accelerate the advance of precision medicine techniques, ultimately ending in a significant improvement in long-term survival. Equally, mobile data collection from digital health tools will transform clinical development through increased data sources, contextual metadata and real-time data.

The Alliance, designed as a non-commercial independent group, is a new way to cooperate together to achieve pretty ambitious goals. It is intended to lead this rising tide to draw attention to this insidious disease and to really affect, in a broad way, the outcomes that we all desire. 

The Alliance promises to deliver innovative medicine to patients by enabling “widespread paradigm shifts”. What does this entail?

We are focused on accelerating the delivery of treatments with potentially curative intent, pushing for earlier intervention when there is still potential for a cure, and placing greater emphasis on early detection of relapse.

We’re prioritising the validation of surrogate endpoints and the identification of predictive biomarkers, which may enable better targeting of tumour characteristics, to accelerate the development of potentially curative treatments.

As part of its Major Pathologic Response Project, the Lung Ambition Alliance is working to validate surrogate endpoints and identify predictive biomarkers, to accelerate the development of curative treatments that harness our understanding of the molecular and genetic underpinnings of cancer that contribute to its growth and progression.

The Alliance’s goal is to ensure the value of predictive biomarkers is widely recognised and that every lung cancer patient has access to biomarker testing at screening, following diagnosis and throughout the treatment journey, in order to inform treatment decisions and stay a step ahead of the disease.


Global Lung Cancer Coalition

Dr Jesme Fox, Secretary of the Global Lung Cancer Coalition

What makes the Lung Ambition Alliance so impactful at this stage in the journey to defeat lung cancer?

This comes at an interesting point in the whole progression of lung cancer in that, for a very long time, nothing really happened. And over the last few years, we've seen a number of things happen: firstly, we've seen the whole focus on early detection, which I think is really key to all of us; our big problem is late diagnosis of lung cancer, which is why our survival rates are so low. We've also had this explosion of new therapies around target treatments and immuno-oncology. There's a huge amount of kind of interest bubbling in lung cancer, and I think we see an opportunity to do something much, much bigger. That's really how the Alliance came together, with interested parties bringing answers to a lot of the questions we have coming down the line. We have mutual interests but come from very different places and different networks.

I've been doing this job for 20 years, and I've not seen something on this global level before. The four founding partners come from very different organisations with different functions, but we all have broad networks that don't really overlap. I think there is a potential for the four founders to reach places where individually we wouldn't otherwise. We're all hopeful that that's the thing that will make the difference.

Each component of the Alliance has its own strengths; what are GLCC’s specialties within the collaboration?

We're a loose coalition of like-minded organisations, local charities, and not-for-profits. We have 30 organisations from 27 countries. My organisation, the UK Roy Castle Lung Cancer Foundation, is the secretariat for that, so we're the hub around which the whole coalition moves forward. What we bring is a local knowledge in individual healthcare systems, because we all work around that, pushing for raising awareness of lung cancer, around access to best-practice treatment and care for lung cancer patients within our own systems, which we all appreciate are actually very different because of the way our healthcare systems are set up.

Do you think that patient advocacy is key in achieving the goal that the collaboration has set out?

I think advocacy itself is about affecting change – that's what we all do in our charities and not-for-profit. Within that, for us in our daily existence, it's about affecting change to improve outcomes for patients. So pushing for treatment, earlier diagnosis, basic treatment, better outcomes are the kind of things that we do all the time, and that's what we bring to this particular initiative.

Although we are a global coalition, the way you make a difference in healthcare is actually very local, because healthcare systems are all very different. So I believe that advocating and understanding of local systems is very important in making these global coalitions work.

What do you see as the biggest barriers on the horizon when it comes to achieving the Alliance’s goal?

For me, there are two key things: one is early detection - if we unlock that, we know we can make a big difference, and because we now have this focus on screening, which is one of the key areas that we're talking about in the Alliance's ambitions moving forward. There is now a potential, because until now we've had the signs and symptoms, which is important, but the problem for lung cancer is signs and symptoms are really quite vague and general, so very often people don't really notice something is wrong until it's too late. But because we now have targeted CT screening, it's about trying to make that happen. The second part to that I think is access to quality patient care. We all know, I think, that there are inadequacies in all health systems, and it's about trying to make existing access as good as it possibly can be, and that doesn't need extra research – that's just about doing the best for everybody that we have at the moment. If we can get over those two things, we will make a huge difference to outcomes in lung cancer.

There are clearly some lofty ambitions in the Alliance. The part that we as GLCC are spearheading is around inviting patient organisations globally to develop and submit proposals addressing inequality in care, thus improving quality of life and survival. I think those will be very local projects because of our local health systems. We plan to launch that later on in the year.


Guardant Health

Dr AmirAli Talasaz, President and Chief Operating Officer of Guardant Health

Early detection is the key to improving survival rates; with this in mind, how does Guardant view its role within the Alliance? How does the work of the Guardant complement the other parties within the partnership?

We have made tremendous progress and are proud of our approach to introducing blood tests, or “liquid biopsies”, that identify specific genomic mutations in cell-free DNA circulating in the blood patients with advanced cancer.

Our flagship test, the Guardant360 assay, has been ordered by more than 6,000 oncologists for more than 100,000 patients with advanced cancer to determine the appropriate therapy. We believe these advances are core to the Alliance’s goals of ensuring both wide recognition of the utility of predictive biomarkers, and that every lung cancer patient has access to biomarker testing to inform treatment decisions. Also, our liquid biopsy tests can be used for treatment monitoring and potentially as a surrogate clinical endpoint to expedite new drug developments.

Additionally, we are building on our cell-free DNA expertise to address additional challenges in oncology, such as screening for cancer and detecting recurrence or evidence of residual disease in early stage cancer patients. By working together with like-minded organisations from the pharmaceutical industry, research community, and patient advocacy, we believe we have a great opportunity to pursue the Alliance’s ambition goals. 

The Alliance aims to improve patient outcomes by addressing the “barriers to early detection” of the disease. What are these barriers and how does the Alliance plan to tackle them?

Despite evidence that lung cancer screening saves lives today, too few patients are screened, even in countries that have adopted screening policies. Part of the problem is the lack of awareness; people just don’t know they should be getting these tests, so raising awareness about screening and its benefits are a good place for the Alliance to focus initially.

We also believe liquid biopsies can play a role in increasing screening compliance. Compared to existing screening methods, blood tests are easy to perform and schedule.

 What is your strategy to action the Alliance’s goal to double five-year survival by 2025? Where do you see the biggest challenges, and how does tackling this as part of the Alliance, rather than alone, help to make this more achievable?

This is an ambitious goal and it’s one we’re proud to share with the other members of the Alliance. Challenges face us in many aspects of lung cancer and we believe this is an ideal opportunity to partner with other key organisations where we have a distinct role.

Despite the large number of genomic targets and associated drugs available today, many patients are still not tested for important predictive biomarkers. We believe Guardant Health has an opportunity to help resolve this, but it will take a concerted effort not just from us but across the field.

We are also excited about the Major Pathologic Response project of the Alliance, which we hope will lead to the validation of surrogate endpoints and the identification of predictive biomarkers to accelerate the identification of potentially curative treatments. This is exactly the type of initiative that requires input and coordination from multiple stakeholders in drug development, patient advocacy, and the academic community.

What do you think sets this initiative apart from previous efforts in the space? Do you think the collaboration’s multi-disciplinary approach is key?

Bringing together the commercial and non-profit sectors is critical. Our diverse perspectives enable us to identify needs more precisely and act upon them faster.

We are confident that the Alliance can help bring this progress to lung cancer. This is a disease for which, despite important breakthroughs in treatment, survival rates after a diagnosis of lung cancer have shown only modest improvement, and lag behind other types of cancer.
